Background
In human immunodeficiency virus (HIV)-infected women, Bowen’s disease may be difficult to successfully treat with surgery alone. Imiquimod cream, effective in treating Bowen’s disease in healthy women, may be a useful postsurgical treatment in immunocompromised women.
Case(s)
Two HIV-infected women had both Bowen’s disease and severe cervical dysplasia. In both cases, Bowen’s disease, but not cervical dysplasia, recurred after surgical treatment. When treated with topical 5% Imiquimod cream twice weekly for 4 months, 70-80% reduction in lesions were observed in both patients. Follow-up biopsies of remaining lesions were vulvar intraepithelial neoplasia (VIN) 1.
Conclusion
Imiquimod cream, in combination with surgical treatment, may be an appropriate strategy for treatment of Bowen’s disease in HIV-infected and other immunocompromised women.
Atypical haemolytic uraemic syndrome (aHUS) is a disease of complement dysregulation and can be fatal if not treated in a timely manner. Although normally associated with triggers such as infection or pregnancy, this case demonstrates acute pancreatitis as the triggering event. The patient’s initial presentation of thrombocytopaenia and acute renal failure was first attributed to a systemic inflammatory response syndrome due to pancreatitis, but with detailed history and further laboratory investigation, we were able to show that patient was having symptoms associated with aHUS. On early recognition of aHUS, this patient was able to receive the proper standard of care with eculizumab and had a full recovery while preventing renal failure. When patients present with thrombocytopaenia and renal failure in acute pancreatitis, we want to ensure physicians keep aHUS on the differential.
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